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INPUT DATA SHEET

MBNN-I: General

Date of collection of the details:


District: Mandal:
Grama Panchayat/Municipality: Habitation /Ward (in case of municipality):

School code no (UDISE):

1. Type of school: PS/UPS/HS/Junior College/KGBV/Model School/APREIS/APSWREIS/APTWREIS

2. Infrastructure existing:-
i. No .of class room : Nos
ii. HM/Principal Rooms : Nos
iii. Staff Room : Nos
iv. Laboratory rooms : Nos
v. Library room : Nos
vi. Toilet blocks:
o Boy’s : Nos
o Girls : Nos
vii. Kitchen shed : Nos
viii. Compound wall (Length in Mts) : Mts
ix. Play field’s : Yes/No
x. Whether Water Source available : Yes/No
If yes: Bore well/GP Tap/Municipal Tap/Others

xi. Whether over head tank available : Yes / No


If Yes : RCC/Syntex
xii. Capacity of the tank (In Lts) : Lts
xiii. Others, if any :

3. Total extent of the land of the School : Acres


4. Plinth area of the existing class room : Sq.Ft
5. Gender category of the school : Boys/Girls/Co-Education
6. Strength of students at present :
7. No of Students a)Boys b)Girls
8. No of sections existing : Nos
9. Whether the existing buildings are in dilapidated condition : Yes /No
10. If yes No. of rooms in dilapidated condition : Nos
INPUT DATA SHEET

Requirement of components :

The Field Engineer in consultation with the HM and Parents committee shall fill the following table

Requirements for the school


status of the component ( Tick
Sl appropriate)
Name of the component
No Requir *Not Partially Remar
ed required required ks
1 Toilets with running water.

Electrification with fans and


2
tube lights.

3 Drinking water supply.

4 Furniture for students and staff.

5 Painting to school.

6 Major and minor repairs.

7 Green chalk boards.

8 English labs

9 Compound walls.

* when you have ticked this , the estimate will not be generated for this component

Signature of the Signature of the Signature of the


Engineering Assistant AE/ AEE HM/Principal
INPUT DATA SHEET

MBNN-II: Toilets with running water

District: Mandal:
Grama Panchayat/Municipality: Habitation /Ward (in case of municipality):

1. Type of school: PS/UPS/HS/Junior college/KGBV/Model


school/APREIS/APSWREIS/APTWREIS
2. No of W.C rooms actual requirement as per student strength : -
Boy’s: Girls :

3. Whether toilet for differently abled persons existing : Yes / No


4. Whether running water available in toilets : Yes / No

If No or Not sufficient:

i. No of W.C rooms (Toilets) now proposed -


Boy’s: Girls : HM/Principal: Staff:
ii. No of Urinals proposed -
Boy’s: HM/Principal: Staff:
iii. No of Wash Basins proposed -
Boy’s: Girls : HM/Principal: Staff:
iv. Sump capacity (In Lts) :
v. Changing room with incinerator for girls students ( only for high schools) : Yes / No
vi. Toilet for differently abled persons (Nos) :
vii. Septic tank :Yes / No

Remarks:

Signature of the Signature of the Signature of the


Engineering Assistant AE/ AEE HM/Principal
INPUT DATA SHEET

MBNN-III: Electrification - Fans and Tube lights

District : Mandal:

Grama Panchayat/Municipality: Habitation /Ward (in case of municipality):


1. Type of school: PS/UPS/HS/Junior college/KGBV/Model
school/APREIS/APSWREIS/APTWREIS

2. Status of the electricity connection from Discom:


Working/disconnected/to be applied for new connection

3. Power bill pending for payment (Rs) :


4. Whether 3 Phase connection available : Yes/No
Electrical fittings proposed
i. High speed fans ( as per the actual requirement ) : Nos
ii. LED Tube Lights (as per the actual requirement ) : Nos
iii. LED Tube Lights for toilets : Nos
iv. Batten Holder with LED bulb : Nos
v. Sockets 16A : Nos
vi. Sockets 6A : Nos
vii. Run off copper wire
a. 1/18 : Mts
b. 3/20 : Mts
c. 7/20 : Mts
viii. PVC conduit pipes of dia : Rmt
ix. Distribution Boards :-
• 4 Way TPN : Nos
• 8 Way TPN : Nos
x. LED Street lights (2 to 4 for PS/UPS and 4 to 6 for High School : Nos

Remarks:

Signature of the Signature of the Signature of the


Engineering Assistant AE/ AEE HM/Principal
INPUT DATA SHEET
MBNN-IV: Drinking water supply

District: Mandal:
Grama Panchayat/Municipality: Habitation/Ward (In case of municipality):

1. Type of school: PS/UPS/HS/Junior college/KGBV/Model


school/APREIS/APSWREIS/APTWREIS
2. Whether source of water available : Yes/No
If yes type of source (Bore well with motor/ GP tap/Municipal tap/others)
If No source required (Bore well with motor/GP tap/Municipal tap/others)
3. Whether G.P Provides safe Drinking water : Yes /No
4. Whether R.O plant existing : Yes /No
5. Whether Dinking water cistern existing :Yes / No

If No or not sufficient

i. Over head tank capacity : Lts


ii. Sump capacity : Lts
iii. Hand wash : Nos

Remarks:

Signature of the Signature of the Signature of the


Engineering Assistant AE/ AEE HM/Principal
INPUT DATA SHEET

MBNN-V: Painting
District : Mandal:
Grama Panchayat/Municipality: Habitation /Ward ( in case of municipality):
1. Type of school: PS/UPS/HS/Junior college/KGBV/Model
school/APREIS/APSWREIS/APTWREIS
2. When was the last painting to class rooms done: ….. No of years
(Blocks / Compound wall - if the colour is done three years and above only shall be considered for painting
now)
3. Whether Emulsion painting required for:-
Inside Rooms:
i. Class rooms block : Yes / No , if yes Wall, Ceiling surface area : …………Sqm

ii. Laboratory block : Yes / No , if yes Wall, Ceiling surface area : …………Sqm

iii. Toilet Block : Yes / No , if yes Wall, Ceiling surface area : ………..Sqm

iv. HM/ Principal : Yes / No , if yes Wall, Ceiling surface area : …………Sqm

v. Staff Room : Yes /No, If yes Wall, Ceiling surface area: ……………Sqm

vi. Kitchen Shed : Yes / No , if yes Wall surface area: …………..Sqm

Outside Rooms:
i. Class rooms block : Yes / No , if yes Wall surface area : …………Sqm

ii. Laboratory block : Yes / No , if yes Wall surface area : …………Sqm

iii. Toilet Block : Yes / No , if yes Wall surface area : …………Sqm

iv. HM/ Principal : Yes / No , if yes Wall surface area : …………Sqm

v. Staff Room : Yes /No, If yes Wall surface area: …………Sqm

vi. Kitchen Shed : Yes / No , if yes Wall surface area::…………Sqm

vii. Compound wall : Yes/ No, if yes Wall surface area both sides: …………Sqm

4. Weather Enamel painting required for:-


i. Doors : Yes / No, if yes no of doors:…………
ii. Windows : Yes / No, if yes no of windows :…………
iii. Ventilators : Yes / No , if yes no of ventilators :…………
iv. Gates : Yes / No , if yes no of gates :…………
v. M.S. Grills : Yes / No
vi. Other if any : Yes / No

Remarks:

Signature of the Signature of the Signature of the


Engineering Assistant AE/ AEE HM/Principal
INPUT DATA SHEET
MBNN-VI: Additional class rooms ( capture the data for future sanctions )

District: Mandal:
Grama Panchayat/Municipality: Habitation/Ward:

1. Type of school: PS/UPS/HS/Junior college/KGBV/Model school/APREIS/APSWREIS/APTWREIS


2. Whether vacant land available for Addl. Class rooms : Yes / No
3. Extent of land available :………….acres
4. No. of class rooms proposed for dismantling (EE has to certify) : ……………. Nos
5. Infrastructure now proposed:-

i. Additional class rooms based on strength :_________Nos


ii. Additional class rooms based on dilapidated condition :_________Nos
iii. Head Master / Principal room :_________Nos
iv. Staff room :_________Nos
v. Laboratory rooms :_________Nos
vi. Library room :_________Nos
vii. Others if any :_________

6. No. of floors proposed : G.F. / G+1 / G+2 ( Beyond G+2 cannot be proposed )
7. If vacant land is not available, whether the existing structure is sound for construction
of First Floor or Second Floor : Yes/No

8. If the existing structure is sound enough no. of additional floors proposed:

Remarks:

Signature of the Signature of the Signature of the


Engineering Assistant AE/ AEE HM/Principal
INPUT DATA SHEET
MBNN-VII: Major and minor repairs

District : Mandal:
GramaPanchayat/Municipality: Habitation/Ward :

1. Type of school: PS/UPS/HS/Junior college/KGBV/Model school/APREIS/APSWREIS/APTWREIS

2. Details of existing infrastructure which requires repairs :-

(Qty in Sq. mts)


Roof ceiling Roof leakage Flooring
 Class rooms :
 Head Master / Principal room :
 Staff room :
 Laboratory rooms :
 Library room :
 Toilet block – Boys :
 Toilet block - Girls
 Kitchen Shed :
 Compound wall :
 Others if any :
3. Compound Wall :
o Gate
 Size in Mts
 Weight in Kgs
o Length of wall (If less than 30 mts):

4. Ramp for differently abled persons - No: Length:


5. Other items of work proposed:
 Dias :__________ mts
 Flag post :__________ Nos
 Foot paths / Path ways (Area in Sq. mts) :__________ Sq. mts
 Name board :__________ Nos
 Other if any :___________

Remarks:

Signature of the Signature of the Signature of the


Engineering Assistant AE/ AEE HM/Principal
INPUT DATA SHEET
MBNN-VIII: Green chalk boards

District : Mandal:
Grama Panchayat /Municipality: Habitation/Ward:

1. Type of school: PS/UPS/HS/Junior college/KGBV/Model school/APREIS/APSWREIS/APTWREIS


2. Students strength :__________ Nos
3. No. of Class Rooms : __________ Nos

i. Existing : __________ Nos


ii. Proposed class rooms by converting the existing verandahs : __________ Nos

4. No. of Laboratories

i. Existing : __________ Nos

5. No. of Green Chalk boards proposed (only in existing rooms) : __________ Nos

Remarks:

Signature of the Signature of the Signature of the


Engineering Assistant AE/ AEE HM/Principal
INPUT DATA SHEET

MBNN-IX: Furniture

District : Mandal:
Grama Panchayat / Municipality: Habitation / Ward:

1. Type of school: PS/UPS/HS/Junior college/KGBV/Model school/APREIS/APSWREIS/APTWREIS


2. Students strength :
3. Furniture proposed as per necessity and requirement :
i. Dual Desks :__________ Nos
ii. Staff Table : __________ Nos
iii. Staff Chair / Class room chair : __________ Nos
iv. Class room Table : __________ Nos
v. Visitor Chairs : __________ Nos
vi. Principal / HM Table ( if not available ) : __________ Nos
vii. Principal / HM Chair ( if not available ) : __________ Nos
viii. Almarahs : __________ Nos
ix. Reading Table for Library : __________ Nos
x. Glass door Almarahs for Library : __________ Nos
xi. Racks ( slotted steel Racks ) : __________ Nos
xii. Stools Stainless steel : __________ Nos
xiii. Dust Bins
a) 80 litres : __________ Nos
b) 15 litres : __________ Nos
xiv. Notice Board : __________ Nos
xv. Podium ( for High schools only ) : __________ Nos
xvi. Computer table (for High schools only) : __________ Nos
xvii. Computer Chairs ( for High schools only ) : __________ Nos
xviii. Laboratory Tables ( for High schools only ) : __________ Nos

Signature of the Signature of the Signature of the


Engineering Assistant AE/ AEE HM/Principal
INPUT DATA SHEET

MBNN-X: Compound wall

District : Mandal:
Grama Panchayat/Municipality: Habitation/Ward :

1. Type of school: PS/UPS/HS/Junior college/KGBV/Model


school/APREIS/APSWREIS/APTWREIS

2. Total Extent of land of the School : Acres


3. Whether compound wall existing : Yes / No

i. For entire extent : _________Rmt


ii. Partly existing : _________Rmt

4. Compound wall now proposed : _________Rmt.


5. Gate proposed : Yes/No

(If compound wall is less than 30 m length the same may be taken up in Major repairs. If the
length is more than 30 m the same may be taken up in MGNREGS)

Remarks:

Signature of the Signature of the Signature of the


Engineering Assistant AE/ AEE HM/Principal

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